Professional Medical Billing Advocates: Services, Costs & How to Choose

Professional medical billing services range from document preparation platforms to full-service advocacy with dedicated case managers. This guide covers what they do, what they cost, and how to decide which level of support is right for your situation.

Critical Distinction: Despite marketing claims of "AI-powered" or "automated" services, virtually all professional medical billing advocacy requires human involvement. True automation is limited to specific tools covered in Technology Solutions. Services in this section include both full-service advocates who personally handle your case and platform-based services that provide tools and support for customer-driven disputes.

For free alternatives, see our Nonprofit & Government Resources guide.

What Medical Billing Advocates Do

Fee Structures

Contingency/Percentage-Based (Most Common)

• Range: 25-35% of total savings achieved
• Standard: 25-33%
• How it works: No upfront cost. Advocate paid only if savings achieved.
• Example: $10,000 bill reduced to $5,000 = $5,000 savings × 30% = $1,500 fee to advocate
• Minimum fees: Some have minimums (e.g., $1,000) even for smaller savings
• No savings = no fee

Hourly Rates

• Some advocates charge by the hour
• Typical case: 10-40 hours of work
• Risk: Pay regardless of outcome
• Note: Request detailed hourly rate quotes from individual advocates

Flat/Fixed Fees

• Some advocates offer flat fees for specific services (bill review, single negotiation, etc.)
• Predictable pricing but doesn't account for complexity
• Request quotes from individual advocates for specific fee structures

Industry Success Metrics

• Error rate: Approximately 30% of bills contain errors (source: University of Minnesota research)
• Average savings: Varies by case; Resolve Medical Bills reports 9 out of 10 clients receive savings
• Timeline: Varies significantly by case complexity

Verified Professional Services

Services verified operational as of October 2025. Accurate categorization of human-assisted vs. automated services.

Resolve Medical Bills

Status: Operational

Website: https://www.resolvemedicalbills.com

Service Model: Human-Assisted (NOT automated)

How It Works: Each client assigned dedicated human advocate who reviews bills, identifies errors/overcharges, negotiates with providers, and handles insurance disputes. Process takes weeks to months, not instant.

Fee Structure:

• Contingency-based (tiered percentage of savings):
  • Bills $5,000-$15,000: 25% of savings
  • Bills $15,000-$200,000: 10% of savings
  • Bills over $200,000: 10% or less of savings
• Minimum fee: $1,000 (for bills with savings under $4,000, minimum is lesser of $1,000 or 50% of savings)
• No savings = no fee (service is free)

Track Record:

• Founded: 2016
• Client savings: $55M+ total
• Success rate: 9 out of 10 patients receive savings
• Average timeline: Varies by case complexity

Best For:

• Complex bills with multiple providers
• Large bills (over $5,000)
• Cases involving billing errors AND negotiations
• People without time to handle personally

Not Suitable For:

• Need instant results
• Very small bills (under $1,000 due to minimum fee)
• Can't wait several months

Health Advocate

Status: Operational

Website: https://www.healthadvocate.com

Service Model: Primarily B2B through employer benefits. Human-assisted with nurses, medical directors, benefits specialists.

Accreditation: NCQA-Certified (National Committee for Quality Assurance)

Services:

• Healthcare navigation and decision support
• Medical bill review and dispute assistance
• Insurance claims assistance and appeals
• Provider-insurance coordination
• Multilingual support available

Important Context: Health Advocate is a comprehensive health benefits platform offered through employers, NOT a specialized medical bill negotiation service. Billing assistance is one component of broader healthcare navigation.

Access:

• Employer-sponsored: No cost to employees whose employers offer the benefit (check with HR)
• Direct-to-consumer: Available through "Health Proponent" service, but fees not publicly disclosed (contact directly)

Best For:

• Employees with employer-provided benefit
• Need comprehensive healthcare navigation beyond just billing
• Want 24/7 multilingual support

Not For:

• Seeking specialized bill negotiation only
• Want transparent direct-to-consumer pricing

Medical Cost Advocate

Status: Operational

Website: https://www.medicalcostadvocate.com

Service Model: Human-Assisted (NOT automated)

How It Works: Full-service negotiation with experienced staff including attorneys, licensed health benefits professionals, and billing/coding specialists (20+ years experience). MCA negotiates with providers AND pays them directly on your behalf to lock in savings.

Fee Structure:

• Contingency-based: 35% of savings
• No upfront fees
• No savings = no fee
• Example: $1,000 bill reduced to $650 = $350 savings, $122.50 fee (35%), net saving $227.50

Payment Process: Unique model where MCA pays provider directly after negotiation. Final reduced amount charged to your credit/debit card, then MCA charges their success fee.

Track Record:

• Founded: 2002 (23 years in business)
• Success rate: 85%+ on reducing out-of-network claims
• Average savings: 30-50% on most bills
• Some bills eliminated completely
• Timeline: Typically less than 1 week

Services:

• Bill negotiation (most requested)
• Payment plan negotiation
• Prospective negotiation (before treatment, for procedures $10K+)

Best For:

• Out-of-network bills
• Self-pay or uninsured services
• Balance bills and remainder bills (deductibles/coinsurance)
• Want fast results (under 1 week vs months)
• Comfortable with 35% contingency fee for speed/expertise
• Large bills where direct payment model adds security

Not Suitable For:

• In-network bills providers refuse to negotiate (payment plans only)
• Bills under $500 (fee may not be worthwhile)
• Want lowest contingency rate (35% is higher than 25-33% industry standard)

Key Differentiators:

• ✅ Direct payment to providers (locks in deal immediately)
• ✅ Very fast timeline (under 1 week)
• ✅ Longest track record (since 2002)
• ✅ Attorney-led for complex cases
• ⚠️ Higher contingency fee (35% vs 25-33% typical)

Document Preparation & Dispute Support

These platform-based services provide structured guidance and tools for disputing medical bills, with some staff support for data entry or document review. Unlike full-service advocates, you complete assessments, approve letters, and handle all provider negotiations yourself.

Patient Fairness

Status: Operational

Website: https://www.patientfairness.com Phone: (615) 991-1177

Service Model: Platform-Assisted Self-Service

How It Works: Platform-based dispute process with staff support for document data extraction. You complete assessments, approve generated letters, and negotiate directly with providers.

Three-Stage Process:

1. Problem Medical Bill Assessment - Complete guided questionnaire about your bill and circumstances. Upload documents for staff to extract data and pre-populate your assessment.
2. Letter of Dispute - Platform generates custom dispute letter based on your assessment. Patient Fairness mails certified letter on your behalf after your approval.
3. Pursue Resolution - Access Medicare price comparison tools, settlement templates, and strategies to negotiate with provider yourself.

Fee Structure:

Fixed pricing based on bill size (no contingency fees):

• Bills ≤$500: $49
• $500-$2,000: $99
• $2,000-$10,000: $199
• $10,000-$20,000: $299
• Bills >$20,000: $499

Payment: $49 initial payment to open case, remaining balance due after 60 days

Guarantee: 60-day satisfaction guarantee - if not satisfied, only pay $49 initial payment

Services Included:

• Guided bill assessment with staff data extraction
• Custom dispute letter generation and certified mailing
• Medicare price comparison analysis
• Hospital cost vs. charges comparison
• No Surprises Act violation checking
• Settlement templates and negotiation tools
• Document tracking and record-keeping

Best For:

• Willing to handle provider negotiations yourself
• Want structured guidance and professional letters
• Bill size makes contingency fees too expensive ($5K+)
• Need Medicare rate comparisons for negotiation leverage
• Want lower cost than full-service advocates

Not Suitable For:

• Want someone to negotiate for you
• No time to manage dispute process yourself
• Need ongoing case management
• Facing legal action (requires attorney)
• Complex multi-provider situations requiring coordination

Key Differences from Full-Service Advocates:

• ❌ No dedicated case manager
• ❌ No negotiation on your behalf
• ❌ No follow-up with providers for you
• ✅ Fixed pricing (not 25-35% contingency)
• ✅ Significantly lower cost
• ✅ You maintain full control of the process

Even lower cost option: Before spending $49-$499, try automated analysis tools like Medical Bill Rescue for instant Medicare rate comparisons at $1.50 per page (most bills are $3-$11 total).

Finding Individual Advocates

If you prefer independent advocate over company:

Professional Certifications

BCPA - Board Certified Patient Advocate (Gold Standard)

• Organization: Patient Advocate Certification Board
• Website: https://www.pacboard.org
• Focus: Comprehensive patient advocacy including medical bills, insurance disputes, care coordination, financial assistance
• Why it matters: Rigorous certification ensuring broad healthcare system knowledge
• Most relevant for: Independent advocates working directly with patients

Other Certifications (Context Important):

CHAA - Certified Healthcare Access Associate

• Organization: NAHAM (National Association of Healthcare Access Management)
• Website: https://www.naham.org
• Focus: Patient access services in healthcare facilities
• Note: For facility staff, not independent advocates

CPB - Certified Professional Biller

• Organization: AAPC (American Academy of Professional Coders)
• Focus: Medical billing for provider practices
• Note: For billing professionals within practices, not patient advocates

Key Distinction: BCPA specifically designed for independent patient advocates. Other certifications (CHAA, CPB, CMRS) designed for professionals working within healthcare facilities or provider practices.

Professional Organizations (Not Certifications)

Alliance of Professional Health Advocates (APHA)

• Website: https://www.aphadvocates.org
• Service: Directory of advocates searchable by location and specialty
• Note: Membership organization, not certification
• Use: Find advocates in your area

Alliance of Claims Assistance Professionals (ACAP)

• Phone: (888) 394-5163
• Focus: Medical claims assistance professionals

When to Use Professional Services

Full-Service Advocates (25-35% Contingency)

• ✅ Very large bills (over $10,000)
• ✅ Multiple providers, complex situations
• ✅ Nonprofit/government resources didn't work
• ✅ No time to manage yourself
• ✅ Complex medical necessity appeals
• ✅ Multiple error types requiring expertise
• ✅ Facing legal action needing immediate intervention
• ✅ Specialized medical situations (cancer, transplant, NICU)

Document Preparation Services ($49-$499 Fixed)

• ✅ Medium bills ($2,000-$20,000) where contingency fees seem excessive
• ✅ Want professional dispute letters but can negotiate yourself
• ✅ Need Medicare rate comparisons for leverage
• ✅ Have time to manage provider communication
• ✅ Straightforward billing disputes without legal complexity
• ✅ Want to maintain control of the process
• ✅ Budget-conscious but need more than DIY tools

Try Nonprofit Resources First

• ⚠️ Smaller bills (under $3,000)
• ⚠️ Obvious errors (duplicates, services not received)
• ⚠️ Straightforward financial assistance applications
• ⚠️ Simple insurance appeals
• ⚠️ You have time to manage
• ⚠️ Clear charity care eligibility

Combined Approach Possible

• Use Patient Advocate Foundation (Nonprofit Resources) for case management
• Hire professional advocate for complex negotiations
• Handle simple disputes yourself
• Get professional help for insurance appeals only

What Advocates Can and Cannot Do

Realistic Outcomes

Achievable:

• Significant savings on bills with errors/excessive charges
• Self-pay discounts negotiated with providers
• Collection settlements below original balance
• Insurance appeals: If successful, full coverage (100% of denied amount)
• Professional documentation and persistent follow-up
• Expertise in navigating complex billing situations

NOT Achievable:

• Make debt disappear without legitimate grounds
• Force insurance to cover excluded services
• Guarantee specific savings percentages
• Create charity care eligibility if don't meet criteria
• Reverse court judgments (requires attorneys)
• Stop lawsuits once filed (requires attorneys)

Realistic Timeline

• Simple bill review: 1-2 weeks
• Error disputes: 2-6 weeks
• Insurance appeals: 4-12 weeks
• Complex negotiations: 2-4 months
• Collection settlements: 1-3 months
• Charity care applications: 4-8 weeks

Timelines assume provider/insurance cooperation. Unresponsive entities extend timeframes significantly.

Next Steps

If considering full-service advocate:

1. Review nonprofit resources unless situation is urgent/complex
2. Get quotes from multiple advocates if using independent professional
3. Verify credentials (look for BCPA certification)
4. Review contract carefully before signing
5. Understand fee structure and timeline

If bill is medium-sized ($2K-$20K) and contingency fees seem excessive:

• Try Patient Fairness for guided dispute support ($49-$499 fixed pricing)
• You'll get professional letters and Medicare comparisons
• You handle provider negotiations yourself
• Much lower cost than full-service advocates

If professional help not needed:

• Continue with Nonprofit Resources
• Apply for hospital charity care (coming soon)
• Handle collections yourself (coming soon)

If facing lawsuit:

• Skip to Legal Services (coming soon) immediately

Want to try self-service first:

• Use Automated Tools for instant analysis
• Start with First Steps guide
• Return to Complete Guide for all options

Remember: Professional advocates can be valuable for complex cases, but many billing issues can be resolved through free resources or automated tools. Evaluate your situation carefully before committing to a 25-35% contingency fee.